Artificial livers - reality or dream? Liver´s the vital important organ plays its role not only in detoxication but in synthesis and supports more than 500 metabolic processes. Without liver is our live threaten within a few days. Acute liver failure survives only 60-70 % patients in Europe as well as in USA but percentage of etiology is various. Acute liver transplantation is only causal therapy of choice but there is the need of immunosupressive therapy during all live even in the case of predictive spontaneous liver function recovery. Artificial and bioartificial liver (BAL) support systems may "to bridge" the patient with acute liver failure (ALF) to transplantation or to spontaneous recovery. Author presents all current methods and prefers the non-biological elimination equipments with own experience with Prometheus (FPSA - Fractionated plasma separation and adsorption) in the treatment of experimental acute liver failure. FPSA significantly improves intracranial pressure, one of the most important marker of acute liver failure. On the other hand only BAL is potential able to make the synthesis of important proteins and physiologically active substances. The idea of hybrid liver support systems, which combine living cells of the liver in an extracorporeal circuit, is potential very hopeful.
Acute liver failure (ALF) is known for extremely high mortality
rate, the result of widespread damage of hepatocytes. Orthotopic
liver transplantation is the only effective therapy but its
application is limited by the scarcity of donor organs. Given the
importance in the liver biology of Wnt/β-catenin signaling
pathway, we hypothesized that its stimulation could enhance
hepatocyte regeneration and attenuate the course of
thioacetamide (TAA)-induced ALF in Lewis rats. Chronic
treatment with Wnt agonist was started either immediately after
hepatotoxic insult (“early treatment”) or when signs of ALF had
developed (“late treatment”). Only 23 % of untreated Lewis rats
survived till the end of experiment. They showed marked
increases in plasma alanine aminotransferase (ALT) activity and
bilirubin and ammonia (NH3) levels; plasma albumin decreased
significantly. “Early” and “late” Wnt agonist treatment raised the
final survival rate to 69 % and 63 %, respectively, and
normalized ALT, NH3, bilirubin and albumin levels. In conclusion,
the results show that treatment with Wnt agonist attenuates the
course of TAA-induced ALF in Lewis rats, both with treatment
initiated immediately after hepatotoxic insult and in the phase
when ALF has already developed. Thus, the pharmacological
stimulation of Wnt/β-catenin signaling pathway can present
a new approach to ALF treatment.
Acute liver failure (ALF) is a clinical syndrome with high mortality rate, resulting from widespread hepatocyte damage. Its pathophysiological background is still poorly understood and preclinical studies evaluating pathophysiology and new potential therapeutic measures are needed. The model of ALF induced by administration of thioacetamide (TAA) in Lewis rats is recommended as optimal; however, the limitation of previous studies was that they were performed predominantly in male rats. In view of the growing recognition that sex as a biological variable should be taken into consideration in preclinical research, we examined its role in the development of TAA-induced ALF in Lewis rats. We found that, first, intact male Lewis rats showed lower survival rate than their female counterparts, due to augmented liver injury documented by higher plasma ammonia, and bilirubin levels and alanine aminotransferase activity. Second, in female rats castration did not alter the course of TAA-induced ALF whereas in the male gonadectomy improved the survival rate and attenuated liver injury, reducing it to levels observed in their female counterparts. In conclusion, we found that Lewis rats show a remarkable sexual dimorphism with respect to TAA-induced ALF, and male rats display dramatically poorer prognosis as compared with the females. We showed that testosterone is responsible for the deterioration of the course of TAA-induced ALF in male rats. In most general terms, our findings indicate that in the preclinical studies of the pathophysiology and treatment of ALF (at least of the TAA-induced form) the sex-linked differences should be seriously considered., Eva Koblihová, Iveta Mrázová, Zdenka Vaňourková, Hana Maxová, Miroslav Ryska, Jiří Froněk., and Obsahuje bibliografii